The Laboratory-Based Intermountain Validated Exacerbation (LIVE) Score Identifies Chronic Obstructive Pulmonary Disease Patients at High Mortality Risk

Abstract

Background: Identifying COPD patients at high risk for mortality or healthcare utilization remains a challenge. A robust system for identifying high-risk COPD patients using Electronic Health Record (EHR) data would empower targeting interventions aimed at ensuring guideline compliance and multimorbidity management. The purpose of this study was to empirically derive, validate, and characterize subgroups of COPD patients based on routinely collected clinical data widely available within the EHR.Methods: Cluster analysis was used in 5,006 patients with COPD at Intermountain to identify clusters based on a large collection of clinical variables. Recursive Partitioning (RP) was then used to determine a preferred tree that assigned patients to clusters based on a parsimonious variable subset. The mortality, COPD exacerbations, and comorbidity profile of the identified groups were examined. The findings were validated in an independent Intermountain cohort and in external cohorts from the United States Veterans Affairs (VA) and University of Chicago Medicine systems.Measurements and Main Results: The RP algorithm identified five LIVE Scores based on laboratory values: albumin, creatinine, chloride, potassium, and hemoglobin. The groups were characterized by increasing risk of mortality. The lowest risk, LIVE Score 5 had 8% 4-year mortality vs. 56% in the highest risk LIVE Score 1 (p < 0.001). These findings were validated in the VA cohort (n = 83,134), an expanded Intermountain cohort (n = 48,871) and in the University of Chicago system (n = 3,236). Higher mortality groups also had higher COPD exacerbation rates and comorbidity rates.Conclusions: In large clinical datasets across different organizations, the LIVE Score utilizes existing laboratory data for COPD patients, and may be used to stratify risk for mortality and COPD exacerbations.

Laboratory-based Intermountain Validated Exacerbation (LIVE) Score stability in patients with chronic obstructive pulmonary disease

“…Before assessing LIVE Score stability across all cohorts, we validated the LIVE Score in the fourth health system (NWKP Health System). COPD diagnosis was defined by billing codes (Blagev et al 18 and online supplementary table 1).…”

“…The Intermountain site extracted EHR laboratory, spirometry, and professional coding data consisting of the variables needed to calculate the LIVE Score, COPD diagnoses, and health outcomes as previously described 18. The tables of the requested variables were available to the research team at Intermountain (DPB, SR and DSC).…”

“…The LIVE Score was previously validated in three health systems showing risk stratification for all-cause mortality, COPD exacerbation frequency and comorbidity rates 18. The LIVE Score validation for the NWKP cohort is reported here.…”

“…Our team has developed and validated the Laboratory-based Intermountain Validated Exacerbation (LIVE) Score in patients with a COPD diagnosis18 using clinically collected electronic health record (EHR) data. This score has five categories of all-cause mortality risk and COPD exacerbation risk ranging from highest risk (LIVE 1) to lowest risk (LIVE 5).…”

“…The LIVE Score has been validated in over 100 000 patients from multiple health systems within USA 18. These included the National Veterans Affairs Health System, comprising over 80 000 patients with COPD from across USA, the University of Chicago Health System, comprising over 2000 patients with COPD who live in an urban area, the Northwest Kaiser Permanente (NWKP) Health System, comprising over 17 000 patients with COPD in north-west USA who have predominantly employment-based insurance coverage, and over 48 000 patients from the Intermountain Healthcare system, which includes a combination of urban and rural patients with COPD from Utah as well as parts of Idaho, Wyoming, and Nevada.…”